Spatial characteristics of optical fields near a gold nanorod revealed by three-dimensional scanning near-field optical microscopy.

We visualize plasmon mode patterns induced in a single gold nanorod by three-dimensional scanning near-field optical microscopy. From the near-field transmission imaging, we find that 3rd and 4th order plasmon modes are resonantly excited in the nanorod. We perform electromagnetic simulations based on the discrete dipole approximation method under focused Gaussian beam illumination and demonstrate that the observed near-field spectral and spatial features are well reproduced by the simulation. We also reveal from the three-dimensional near-field microscopy that the 4th order plasmon mode confines optical fields more tightly compared with the 3rd order mode. This result indicates that the even-order plasmon modes are promising for enhancing the light-matter interactions.

[A Multicenter Questionnaire Survey of Postoperative Delirium -National Hospital Organization, Surgery and Anesthesia Network Group-].

BACKGROUND: Postoperative delirium in the elderly is associated with increased morbidity and risk of injury. However, the opinion of attending surgeons and anes- thesiologists regarding postoperative delirium is uncer- tain, as is the prevention and treatment of the condi- tion, in Japanese hospitals. METHODS: We conducted a multicenter questionnaire survey about postoperative delirium. Survey sheets were sent to 40 hospitals belonging to the National Hospital Organization. RESULTS: Wide variation in the answers from 26 hospitals revealed no common understanding regarding the diagnosis and management of postoperative delir- ium. The incidence of postoperative delirium was reported as 20-30%. It developed on postoperative day 2, with recovery within 1 month. Age, postoperative complications, alcohol abuse, cognitive impairment, sex, and depth of anesthesia were considered to be risk fac- tors. Prevention and treatment strategies included pain control, encouraging normal sleep-wake cycles, and avoiding postoperative complications. Although phar- macologic management with haloperidol or risperidone was also adopted in many facilities, the effect was thought to be uncertain. All respondents agreed that an enormous effort was required in caring for patients with postoperative delirium. CONCLUSIONS: Prospective clinical studies are neces- sary for improving the management of elderly patients with postoperative delirium.

Virtual reconstruction of the Neanderthal Amud 1 cranium.

OBJECTIVES: We describe a new computer reconstruction to obtain complete anatomical information of the ecto- and endocranium from the imperfectly preserved skull of the Neanderthal Amud 1. MATERIALS AND METHODS: Data were obtained from computed tomography scans of the fossil cranium. Adhesive and plaster were then virtually removed from the original specimen, and the fragments comprising the fossil cranium were separated. These fragments were then mathematically reassembled based on the smoothness of the joints. Both sides of the cranium were reassembled separately, and then aligned based on bilateral symmetry and the distance between the mandibular fossae obtained from the associated mandible. The position of the isolated maxilla was determined based on the position of the mandible that was anatomically articulated to the mandibular fossae. To restore missing basicranial and damaged endocranial regions, the cranium of Forbes' Quarry 1 was warped onto that of La Chapelle-aux-Saints 1, and the resulting composite Neanderthal cranium was then warped onto the reconstructed Amud 1 by an iterative thin-plate spline deformation. RESULTS: Comparison of the computer reconstruction with the original indicated that the newly reconstructed Amud 1 cranium was slightly shorter and wider in the anteroposterior and mediolateral directions, respectively, suggesting that it was relatively more brachycephalic. The endocranial volume was estimated to be 1,736 cm3 , which was quite similar to the original estimated value of 1,740 cm3 . DISCUSSION: This new computer reconstruction enables not only measurement of new cranial metrics, but also inclusion of the Amud 1 specimen in three-dimensional geometric morphometric analyses that were previously difficult due to its incompleteness. Am J Phys Anthropol 158:185-197, 2015. © 2015 Wiley Periodicals, Inc.

Learning Self-Prior for Mesh Inpainting Using Self-Supervised Graph Convolutional Networks.

This study presents a self-prior-based mesh inpainting framework that requires only an incomplete mesh as input, without the need for any training datasets. Additionally, our method maintains the polygonal mesh format throughout the inpainting process without converting the shape format to an intermediate, such as a voxel grid, a point cloud, or an implicit function, which are typically considered easier for deep neural networks to process. To achieve this goal, we introduce two graph convolutional networks (GCNs): single-resolution GCN (SGCN) and multi-resolution GCN (MGCN), both trained in a self-supervised manner. Our approach refines a watertight mesh obtained from the initial hole filling to generate a completed output mesh. Specifically, we train the GCNs to deform an oversmoothed version of the input mesh into the expected completed shape. To supervise the GCNs for accurate vertex displacements, despite the unknown correct displacements at real holes, we utilize multiple sets of meshes with several connected regions marked as fake holes. The correct displacements are known for vertices in these fake holes, enabling network training with loss functions that assess the accuracy of displacement vectors estimated by the GCNs. We demonstrate that our method outperforms traditional dataset-independent approaches and exhibits greater robustness compared to other deep-learning-based methods for shapes that less frequently appear in shape datasets.

Influencing factors on cardiac structure and function beyond glycemic control in patients with type 2 diabetes mellitus.

BACKGROUND: We hypothesized that clinical factors other than glycemic control may influence abnormal cardiac function in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the independent factors for abnormal cardiac function among clinical factors in T2DM. METHODS: We studied 148 asymptomatic patients with T2DM without overt heart disease. Echocardiographic findings were compared between diabetic patients and 68 age-matched healthy subjects. Early (E) and late (A) diastolic mitral flow velocity and early diastolic mitral annular velocity (e') were measured for assessing left ventricular (LV) diastolic function. We evaluated insulin resistance, non-esterified fatty acid, high-sensitive CRP, estimated glomerular filtration rate, waist/hip ratio, abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and other clinical characteristics in addition to glycemic control. VAT and SAT were quantified by computed tomography. RESULTS: In T2DM, E/A and e' were significantly lower, and E/e', left atrial volume and LV mass were significantly greater than in control subjects. In multivariate liner regression analysis, VAT was an independent determinant of left atrial volume (ß =0.203, p=0.011), E/A (ß =-0.208, p=0.002), e' (ß =-0.354, p<0.001) and E/e' (ß=0.220, p=0.003). Age was also an independent determinant, whereas fasting plasma glucose and hemoglobin A1c levels were not. In addition to systolic blood pressure, waist-hip ratio (ß=0.173, p=0.024) and VAT/SAT ratio (ß=0.162, p=0.049) were independent determinants of LV mass. CONCLUSION: Excessive visceral fat accompanied by adipocyte dysfunction may play a greater role than glycemic control in the development of diastolic dysfunction and LV hypertrophy in T2DM.

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease.

BACKGROUND: Cardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients. METHODS: From February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery. RESULTS: There were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5. CONCLUSIONS: CFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.

Clinical factors associated with classical symptoms of aortic valve stenosis.

BACKGROUND AND AIM OF THE STUDY: The recognition of clinical symptoms is critical to a therapeutic strategy for aortic valve stenosis (AS). It was hypothesized that AS symptoms might have multiple causes; hence, a study was conducted to investigate the factors that separately influence the classic symptoms of dyspnea, angina and syncope in AS. METHODS: The medical records of 170 consecutive patients with AS (> or = moderate grade) were reviewed. A multivariate logistic regression analysis was used to evaluate the hemodynamic and clinical factors that separately influence the development of three clinical symptoms: dyspnea (defined as NYHA class > or = 2), angina, and syncope. RESULTS: The most common symptom was dyspnea (47.1%), followed by angina (12.4%) and syncope (4.7%). The factors associated with dyspnea were a higher e' ratio (p = 0.04) and peak aortic valve velocity (p = 0.01). Only the severity of AS was associated with syncope. The presence of hypertension was associated with angina (p = 0.04). Moreover, coronary angiography was performed in 59 patients before aortic valve replacement and revealed coronary stenosis (> 50% diameter stenosis) in 11/16 patients (69%) that had angina. The presence of coronary stenosis was significantly associated with angina (p = 0.02). The development of dyspnea, angina or syncope was influenced by different factors in AS. CONCLUSION: Dyspnea and syncope were mainly associated with AS severity, and diastolic dysfunction also influenced dyspnea. In contrast, angina was mainly related to the presence of coronary stenosis rather than to AS severity. These factors should be considered when, selecting a therapeutic strategy for AS patients in the modern era.

Technical note: Quantification of neurocranial shape variation using the shortest paths connecting pairs of anatomical landmarks.

Three-dimensional geometric morphometric techniques have been widely used in quantitative comparisons of craniofacial morphology in humans and nonhuman primates. However, few anatomical landmarks can actually be defined on the neurocranium. In this study, an alternative method is proposed for defining semi-landmarks on neurocranial surfaces for use in detailed analysis of cranial shape. Specifically, midsagittal, nuchal, and temporal lines were approximated using Bezier curves and equally spaced points along each of the curves were defined as semi-landmarks. The shortest paths connecting pairs of anatomical landmarks as well as semi-landmarks were then calculated in order to represent the surface morphology between landmarks using equally spaced points along the paths. To evaluate the efficacy of this method, the previously outlined technique was used in morphological analysis of sexual dimorphism in modern Japanese crania. The study sample comprised 22 specimens that were used to generate 110 anatomical semi-landmarks, which were used in geometric morphometric analysis. Although variations due to sexual dimorphism in human crania are very small, differences could be identified using the proposed landmark placement, which demonstrated the efficacy of the proposed method.

Prediction of coronary artery stenosis at rest in patients with normal left ventricular wall motion. Segmental analyses using strain imaging diastolic index.

Noninvasive detection of coronary artery stenosis usually requires a stress test in patients without left ventricular (LV) regional wall motion abnormalities (RWMA). In contrast, abnormal regional LV relaxation caused by ischemia may persist beyond recovery from transient ischemia. The aim of the present study was to determine whether segmental analysis of abnormal regional LV relaxation using the strain imaging diastolic index (SI-DI) at rest could predict coronary artery stenosis in the three major vessels in patients without LV dysfunction or RWMA. We performed 2D speckle tracking echocardiography and coronary angiography in 85 patients without RWMA with suspected coronary artery disease. Patients with LV dysfunction or acute coronary syndrome were excluded. Echocardiographic images of the LV were obtained in the apical 2-, 3-, and 4-chamber views and divided into 6 segments. In each segment, SI-DI derived from transverse strain imaging was determined. Forty-eight patients had significant coronary artery stenosis (≥ 70%). The optimal cutoff values of SI-DI were 60.5% in the mid anteroseptal segment for detecting left anterior descending artery stenosis (sensitivity, 83.3%; specificity, 81.1%), 60.5% in the basal anterolateral segment for detecting left circumflex artery stenosis (sensitivity, 80.9%; specificity, 90.3%), and 61.5% in the basal inferior segment for detecting right coronary artery stenosis (sensitivity, 74.1%; specificity, 77.8%). A segmental analysis of SI-DI at rest predicted coronary artery stenosis in the three major vessels in patients without RWMA. This noninvasive method may be useful for detecting coronary artery stenosis without a stress test.

Phlegmonous duodenitis in an immunocompromised patient.

Phlegmonous duodenitis is an extremely rare condition, and only a few cases have been previously reported. Here, we report a case of phlegmonous duodenitis caused by Streptococcus parasanguinis and Escherichia coli in a 78-year-old immunocompromised patient with diabetes mellitus and immunosuppressive drugs. Abdominal computed tomography showed diffuse thickening of the duodenum and gastric antrum, and esophagogastroduodenoscopy revealed some erosions with purulent discharge and reddish and edematous mucosa in the duodenal bulb. A bacteriological culture test detected the two abovementioned bacteria and established the diagnosis of phlegmonous duodenitis. Following the initiation of antibiotic treatment, his condition rapidly improved. Endoscopists should be aware of this rare entity and pay attention to the endoscopic duodenal findings similar to those of phlegmonous gastritis, particularly in immunocompromised patients who develop abdominal symptoms with severe inflammation.

A Case of Usefulness of Auto-Injectable Adrenaline as a Prophylactic Countermeasure Against Bee Sting for Forestry Workers.

Since 2015, the Ministry of Agriculture, Forestry and Fisheries in Japan has put in place regulations for forestry workers with bee or wasp allergies. These regulations allow workers to carry auto-injectable adrenaline when they engage in forestry work. A 48-year-old male worker identified as having a bee allergy was provided with an auto-injectable adrenaline prescription. The worker had experienced bee stings several times but never had an anaphylactic reaction. However, after suffering two bee stings to the head and face region, he developed an anaphylactic condition. He used the auto-injectable adrenaline on himself and was transported to an acute critical care center. The worker received additional injection of adrenaline at the health center for residual symptoms. The worker survived with no adverses outcome. The present study described the usefulness of prescribed auto-injectable adrenaline as a prophylactic countermeasure against bee stings for forestry workers with documented allergies. This framework may be useful for protecting forestry workers around the world.

Hiatal Hernia with Prolapse of the Pancreas Causing Bile Duct Stricture and Liver Function Disorders: A Case Report and Literature Review.

Hiatal hernia is a common condition in elderly patients, but the additional presence of prolapse of the pancreas is extremely rare. We herein report an 89-year-old woman who presented with liver function disorders and abdominal pain. Her laboratory tests revealed cholestasis, and imaging examinations showed stenosis of the common bile duct pulled toward the hernia sac. She was diagnosed with a common bile duct stricture due to pancreatic herniation and underwent laparoscopic surgery. Our review of the literature identified three types of pancreatic herniations: asymptomatic, bile duct complication, and acute pancreatitis. Pancreatic head herniation tends to induce bile duct complications.

Bowel Obstruction due to Shiitake Mushrooms: Diagnostic Features on Computed Tomography.

Shiitake mushrooms are edible mushrooms popular in East Asian cuisine. We herein report a 69-year-old man with abdominal distension and vomiting after ingesting several pieces of sautéed Shiitake mushrooms. Abdominal computed tomography (CT) revealed ring-shaped and crescent-shaped low-density objects (-100 to -300 Hounsfield units) in the ileum. Based on the specific shapes and CT numbers of the foreign bodies, he was diagnosed with small bowel obstruction due to Shiitake mushrooms. After conservative treatment, he passed four pieces of Shiitake mushrooms. Despite the rarity, the condition can be diagnosed before exploratory surgery by careful and detailed interpretation of CT findings.

Global longitudinal strain in relation to the severity of aortic stenosis: a two-dimensional speckle-tracking study.

BACKGROUND: Global longitudinal strain (GLS) measured by two-dimensional speckle tracking imaging (2D-STI) has been shown to be useful for assessing subtle change in left ventricular function in severe aortic stenosis (AS) patients with preserved left ventricular ejection fraction (LVEF). However, there is little information about the relation between the progression of AS and changes in GLS. The aim of this study was to evaluate the relation between the severity of valve stenosis and GLS measured by 2D-STI in AS patients with normal LVEF. METHODS: We studied 113 AS patients (age, 73.3 ± 8.8 years; male, 38%; aortic valve area (AVA), 1.0 ± 0.3 cm(2); mean pressure gradient (PG), 33.8 ± 22.1 mmHg) with normal LVEF (≥50%) but without overt coronary artery disease. Patients were stratified into three groups (mild, moderate and severe AS), and the clinical characteristics and echocardiographic findings were compared among the groups. Using dedicated software, we measured GLS in the apical four-chamber view. RESULTS: LVEF was not significantly different among the three groups. However GLS showed significant differences in GLS among the three groups (mild: 17.1 ± 3.0%, moderate: 16.4 ± 3.0% and severe: 14.5 ± 3.9%, ANOVA P = 0.003). GLS was significantly correlated with AVA, mean PG, LVEF, LV mass index and early diastolic mitral annular velocity (e'). In multiple stepwise regression analysis, mean PG, LVEF and hypertension were independently associated with GLS (R(2) = 0.247, P = 0.0001). CONCLUSIONS: Despite unchanged LVEF, GLS gradually decreased as severity of AS increases. GLS measured by 2D-STI might be useful to assess subtle changes in LV function in AS patients.

Characterization of Overlapped Plasmon Modes in a Gold Hexagonal Plate Revealed by Three-Dimensional Near-Field Optical Microscopy.

A detailed characterization of plasmon modes is important not only for a deeper understanding of plasmons but also for their practical applications. In this study, we investigated the three-dimensional near-field characteristics of high-order plasmon modes excited in a gold hexagonal nanoplate. From the near-field spectroscopic images, we found that both in-plane and out-of-plane plasmon modes observed near 900 nm were spectrally and spatially overlapped. We performed three-dimensional near-field measurement to reveal the optical characteristics of the overlapped modes in detail. We found that the steric near-field distribution near the nanoplate strongly depended on the plasmon mode, and the out-of-plane mode confines electromagnetic fields more tightly than the in-plane mode. We also found that the in-plane mode was dominantly visualized as the probe tip-sample distance increased. These findings demonstrate that the three-dimensional near-field technique enables selective visualization of a single plasmon mode even if multiple modes are spatially and spectrally overlapped.

Glance behavior as design indices of in-vehicle visual support system: A study using crane simulators.

A prediction model is used to predict subjective responses of crane operators with respect to different designs of In-Vehicle Visual Support (IVVS). Selected gaze metrics are used as objective metrics to minimize prejudice, which is commonly caused by subjective measures. Experiments are carried out using crane simulator to measure glance behavior of novice operators and the 3D perspective projection method is used for autonomous mapping of gaze fixations to dynamic Area-of-Interests (AOIs). Subjective responses, such as operators' emotion and usability of IVVS, are evaluated using the Likert scale of the Semantic Differential method. Correlation between gaze metrics and subjective responses is established using multiple linear regression. Glance behavior exhibits a statistically significant difference when information on IVVS is perceived as useful to ease operation and reduce tension. Despite this, there are no significant signs of distraction. Glance behavior is found to be a reliable sub-conscious indicator of subjective response and distraction. More importantly, the proposed gaze metrics are found to be a good representation of glance behavior, such as randomness and distribution of attention. The methods and findings are useful to evaluate impact of IVVS, which is becoming more common in many other applications.

Reconstructing the Neanderthal brain using computational anatomy.

The present study attempted to reconstruct 3D brain shape of Neanderthals and early Homo sapiens based on computational neuroanatomy. We found that early Homo sapiens had relatively larger cerebellar hemispheres but a smaller occipital region in the cerebrum than Neanderthals long before the time that Neanderthals disappeared. Further, using behavioural and structural imaging data of living humans, the abilities such as cognitive flexibility, attention, the language processing, episodic and working memory capacity were positively correlated with size-adjusted cerebellar volume. As the cerebellar hemispheres are structured as a large array of uniform neural modules, a larger cerebellum may possess a larger capacity for cognitive information processing. Such a neuroanatomical difference in the cerebellum may have caused important differences in cognitive and social abilities between the two species and might have contributed to the replacement of Neanderthals by early Homo sapiens.

[Successful case of obstructing shunt flow of arteriovenous malformation by a pulmonary artery catheter : a case report].

A 75-year-old woman was scheduled for the right partial pulmonary resection, because of severe hypoxemia caused by monofocal arteriovenous malformation. Before the operation, we obstructed successfully the shunt flow of arteriovenous malformation by using a balloon of pulmonary artery catheter. The hypoxemia was improved remarkably and we could control anesthesia safely.

Automatic extraction of endocranial surfaces from CT images of crania.

The authors present a method for extracting polygon data of endocranial surfaces from CT images of human crania. Based on the fact that the endocast is the largest empty space in the crania, we automate a procedure for endocast extraction by integrating several image processing techniques. Given CT images of human crania, the proposed method extracts endocranial surfaces by the following three steps. The first step is binarization in order to fill void structures, such as diploic space and cracks in the skull. We use a void detection method based on mathematical morphology. The second step is watershed-based segmentation of the endocranial part from the binary image of the CT image. Here, we introduce an automatic initial seed assignment method for the endocranial region using the distance field of the binary image. The final step is partial polygonization of the CT images using the segmentation results as mask images. The resulting polygons represent only the endocranial part, and the closed manifold surfaces are computed even though the endocast is not isolated in the cranium. Since only the isovalue threshold and the size of void structures are required, the procedure is not dependent on the experience of the user. The present paper also demonstrates that the proposed method can extract polygon data of endocasts from CT images of various crania.